| NPI | 1194955526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 018170) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: NY 11039) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2017-04-07 |